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How the great detective work of contact tracers saved many German lives

US cities battling to contain the virus’s spread are trying to mirror Germany’s aggressive and highly successful tracing techniques

18 May 2020 - 16:21 Naomi Kresge

Anni Adams looks at new app to trace contacts with people potentially infected with the coronavirus disease (COVID-19), May 5, 2020. Picture: REUTERS /ISLA BINNIE

Berlin — Infections were never Joachim Lazarek’s speciality. People are. But when the new coronavirus swept into Würzburg, Germany, in early March, the 39-year-old social worker found himself on the front lines fighting it as one of the city’s scores of contact tracers.

It’s like detective work: When someone in Würzburg tests positive for the virus, Lazarek conducts interviews to follow any trail of illness the person might have left in their wake, getting in touch with their contacts to advise them to quarantine and keep a diary of their health and anyone they meet.

“We try to understand the person at the other end of the line and get a picture of their whole lives,” Lazarek says. “Did you talk over the fence with someone? Were you at the doctor? Were you walking with your partner?”

Unlike the US, the UK, and most other countries, Germany never gave up on contact tracing even as infections ballooned. Thanks to some of the world’s toughest privacy laws, the country’s 375 local health authorities couldn’t rely on digital surveillance for help. Instead, they recruited teams ranging from medical students to firefighters, who work via e-mail, telephone, and sometimes even fax. Their success is a key reason Germany has about a third the number of coronavirus deaths per capita as the US.

Germany’s tracing and testing put it in a good position to suppress any new infection clusters that pop up as it emerges from lockdown, according to Mike Ryan, executive director of the World Health Organisation’s emergencies programme. “Shutting your eyes and trying to drive through this blind is about as silly an equation as I’ve seen,” Ryan said in a May 11 briefing. “Certain countries are setting themselves up for some seriously blind driving over the next few months.”

As the US boosts efforts to follow the infection’s path through communities, it will need more than 100,000 people such as Lazarek to man the phones and hit the pavement — at a total cost in the billions. New York City says it plans to hire as many as 10,000. In Massachusetts, more than 45,000 people applied for about 1,400 jobs as contact tracers. New Jersey plans to hire at least 1,000 to supplement the work of 900 local health officials. All three states have cited Germany as a model.

Germany has been “very aggressive in their contact tracing,” New Jersey commissioner of health Judith Persichilli told reporters last month. “Their experience can inform our efforts as we look ahead, to ease some of our social distancing restrictions.”

Würzburg, a city of 130,000 about an hour east of Frankfurt by car, offers a case study in the effectiveness of low-tech contact tracing. The first two virus infections emerged on March 4, in people who had just returned from Italy. Before testing positive, they visited local relatives — and by March 5, three more family members were infected. The health authority staff started making calls.

While they had some experience with pandemic response from swine flu, it quickly became clear this would be on a different scale. New cases kept emerging: a young couple, a student and teacher who had been in the Alps, a handful of other schoolchildren, and a university employee who commuted into the city. Most worryingly, the virus emerged in the Ehehaltenhaus-St Nikolaus nursing home. On March 12, an 83-year-old resident of the facility became the first person in Bavaria to die from the virus.

The health authority for Würzburg and the surrounding region soon realised there were too many cases for its staff to track, so the group started pulling in people from other departments. Lazarek, who worked with mentally ill adults, joined the team on March 9. “Covid-19 patients became everybody’s main job,” he recalls.

It was a Sisyphean endeavour. Lazarek and the other contact tracers — about 20 people initially — report to work every morning for a meeting at which the day’s cases are handed out. When Lazarek calls someone who has tested positive, he first must gently break the news that the person has Covid-19. “It’s about taking away people’s fears and informing them very clearly what they can do,” he says.

Once he’s established a rapport, he tells the patient how to quarantine. Then he begins the laborious process of making a list of everyone the infected person had face-to-face contact with for more than 15 minutes starting two days before their symptoms began.

Patients are given the opportunity to call their contacts themselves first, to give them a heads-up about what’s coming. But Lazarek and the other tracers must also get on the phone to explain that each person has to quarantine at home for two weeks. These people are instructed to track their health and note any encounters — even as fleeting as a package delivery person at the door. If they develop symptoms, they’re tested, and for those who test positive, a tracker goes back to the beginning to investigate that person’s contact chain.

In the early weeks, the cases piled up. On March 20, when Bavarian premier Markus Söder put the state into lockdown, the Würzburg area had 54 new infections. “We worked six or seven days straight, sometimes 10 to 14 hours a day,” Lazarek says. “We barely even looked at the clock. It was just important to get to the bottom of a case.”

The health authority started recruiting outsiders to double the contact-tracing team, to about 40 people, signing up students, youth welfare officers, and administrators from other agencies. They added people to manage the tide of paperwork, and they soon outgrew their clunky Excel spreadsheets, shifting instead to a more powerful database program. Counting back-office staff, contact tracers, and doctors who oversee quarantines, the team swelled to more than 100 people.

By late April, Lazarek — who had become a team leader and then a trainer — slowly began to see the effects of his work. On April 24, for the first time, there were no new virus cases to distribute at the morning meeting. By May 15, the team had released about 2,500 people from quarantine, 728 of the area’s 869 virus cases had recovered, and 59 people had died.

Würzburg is just one small cog in the German contact tracing machine. The Bavarian state government has promised 3,000 more personnel for health authorities to fight the virus, and across Germany the federal government says it’s aiming for a team of five tracers per 20,000 inhabitants — almost 21,000 people nationwide.

As Germany slowly eases restrictions on public life, the work of Lazarek and other contact tracers is far from over. The number of cases in Germany has ticked up slightly, driven by local outbreaks in meatpacking plants and nursing homes. On May 11, chancellor Angela Merkel praised the work of health authorities, and said they remain the key to tracking and shutting down new chains of infection. “Committed people are working there,” she said. “They will manage this task, and we’ll provide the backup they need.”